Revascularization among patients with severe left ventricular dysfunction: a meta‐analysis of observational studies

Abstract

AimsCoronary artery bypass graft (CABG) surgery is the standard of care for the management of patients with severe three-vessel and left main coronary artery disease (CAD). However, the optimal strategy for management of patients with CAD and severe left ventricular (LV) dysfunction [ejection fraction (EF) ≤35%] is not clear. A meta-analysis of observational studies was performed to determine the operative mortality and long-term (5-year actuarial survival) outcomes among patients with severe LV dysfunction undergoing CABG. Methods and resultsA systematic computerized literature search was performed and observational studies consisting of patients undergoing isolated CABG for CAD and severe LV dysfunction were included. Studies that did not report operative mortality, long-term (≥1 year) survival data, or pre-operative EF and multiple studies from the same group were excluded. In total, 4119 patients from 26 observational clinical studies were included. The estimated mean age was 63.9 years and 82.4% of patients were men. The mean (estimate) pre-operative EF was 24.7% (95% CI 22.5-27.0%). The operative mortality among patients (26 studies, n ¼ 3621) who underwent on-pump CABG was 5.4%, n ¼ 189 (95% CI 4.5 -6.4%). The 5-year actuarial survival among patients (13 studies, n ¼ 1980) who underwent on-pump CABG was 73.4%, n ¼ 1483 (95% CI 68.7-77.7%). Patients who underwent off-pump CABG (7 studies, n ¼ 498) tended to have reduced operative mortality of 4.4%, n ¼ 20 (95% CI 2.8-6.4%). The mean (estimate) post-operative EF was . ConclusionThe present meta-analysis demonstrates that based on data from available observational clinical studies, CABG can be performed with acceptable operative mortality and 5-year actuarial survival in patients with severe LV dysfunction.--

Managing Heart Failure Patients with Multivessel Disease — Coronary Artery Bypass Graft versus Percutaneous Coronary Intervention

“…10 Kunadian and co-workers conducted a meta-analysis of observational studies including 4,119 patients with a mean age of 64 years and an LVEF of approximately 25 % in those receiving surgical revascularisation. 11 The perioperative mortality rate was around 5 %, which is similar to the 4 % noted in the Surgical Treatment for Ischaemic Heart Failure (STICH) trial. 12 The observed 5-year survival rate was 73 % which is similar to that of modern medical treatment in a similar age group and much better than that seen in patients who received coronary intervention in either of the earlier trials of revascularisation.…”

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

“…160 . Metanálise demonstrou que a revascularização pode ser realizada em pacientes com disfunção ventricular com aceitável mortalidade em torno de 5% 161 . Entretanto, pode haver substrato heterogêneo consistindo da mistura de fibrose, músculo atordoado, hibernado e remodelado em várias proporções nos pacientes com miocardiopatia isquêmica 162 .…”

Long-Term Follow-Up of Outcomes With F-18-Fluorodeoxyglucose Positron Emission Tomography Imaging–Assisted Management of Patients With Severe Left Ventricular Dysfunction Secondary to Coronary Disease

“…1,2 There is a large body of predominantly observational data to demonstrate that restoration of blood flow to dysfunctional myocardium in the territory of a stenosed coronary artery is beneficial, [3][4][5] but controversies remain regarding surgical revascularization, Background-Whether viability imaging can impact long-term patient outcomes is uncertain. The PARR-2 study (Positron Emission Tomography and Recovery Following Revascularization) showed a nonsignificant trend toward improved outcomes at 1 year using an F-18-fluorodeoxyglucose positron emission tomography (PET)-assisted strategy in patients with suspected ischemic cardiomyopathy.…”